A canker sore is a small, painful sore that develops inside the mouth. Also known as aphthous ulcers, these shallow sores can be found on or under the tongue, inside your cheek or lip, at the base of the gums or on the soft palate. Canker sores can appear on their own or in groups and are recurrent.
Although canker sores can be painful, they will usually clear on their own within one to two weeks. If your canker sore is persistent, unusually large or particularly painful, or if the sores are spreading, your dentist may prescribe a corticosteroid ointment or antimicrobial mouth rinse. Over-the-counter solutions may also be recommended to reduce pain and irritation. You are also recommended to rinse the mouth with a warm-water solution and avoid eating any acidic, citrus or spicy foods that may irritate the ulcer.
Canker sores are sometimes split into two categories:
- Simple canker sores: they appear 3-4 times a year; they generally occur in people aged 10-20, and last about 1 week.
- Complex canker sores: less common, larger, and more painful. They may last up to 1 month and leave a scar. Complex canker sores are often due to an underlying condition, such as a compromised immune system, Crohn’s disease, or vitamin
While there can be some rare factors for an individual, these five reasons are the most common and widespread causes of canker sores among all and sundry.
Most problems of the skin and outermost layers of the human body in areas such as the inside of the mouth are owing to vitamin deficiencies. In case of canker sores, the specific vitamin is B-12. Kids require more vitamins than adults because they are consistently growing and the body keeps demanding more vitamins. Also, kids are the most averse to vitamins. Fruits and vegetables are not typically a dear favorite of the young guns. Thus, vitamin B-12 deficiency is rather common among kids. If this is the cause of canker sores, then taking vitamin capsules or applying the contents of vitamin B-12 capsules directly to areas where sores have developed can offer quick and painless results.
It has been noted in several studies that canker sores are either caused or triggered further when there is a deficiency of folic acid, zinc, or iron in the human body. Deficiencies of calcium can also cause canker sores, but more than causing them, calcium deficiency can worsen the situation. Healthy eating is the best solution to such a nutritional deficiency.
Stress on the tissues or any type of injury in the mouth can cause canker sores. Since the sores are actually tiny ulcers, they can be caused by any kind of hard brushing or eating something that can cause bruises or lead to tissue inflammation in the mouth. Also, many people suffer from injuries from dental equipment such as braces. Using harsh mouthwashes or oral products that can damage the outermost layering of the mouth can also lead to canker sores. Poorly fitted dentures, brushing too roughly, not keeping the mouth clean, or using any harsh product can lead to stress or injury of the tissues and that may cause canker sores!
Fruits and vegetables
Ironically, some fruits that are considered to be very healthy due to their nutrients are actually not desirable when one has canker sores. Many citrus fruits are highly acidic and can cause or worsen canker sores. While it is not entirely accurate to state that fruits such as oranges, lemons, or pineapples can in and of themselves cause canker sores, they can when there is already some stress on the tissues and the surfaces inside the mouth are prone to burn or react to the acidic nature of the fruits. Strawberries, figs, tomatoes, and apples are some of the foods that should be avoided if one has canker sores.
Poor immune system
People who have a poor immune system are more prone to canker sores. It is difficult to find a specific correlation of immune system with canker sores and pinpoint what exactly is in one’s immunity that triggers canker sores, but the fact that the immune system cannot prevent or repair it quickly is reason enough to consider it to be a contributing factor. Besides, there is evidence that gastrointestinal problems and other diseases contribute to or cause canker sores.
Symptoms usually begin with pain or burning, followed in 1 to 2 days by a canker sore. There is never a blister. Pain is severe—far more so than would be expected from something so small—and lasts 4 to 7 days. The canker sores almost always form on soft, loose tissue such as that on the inside of the lip or cheek, on the tongue, on the floor of the mouth, on the soft palate, or in the throat. Sores appear as shallow, round, or oval spots with a yellow-gray center and a red border. Usually, sores are small, about 1/8 to 3/8 inches (less than 1 centimeter) in diameter, and often appear in clusters of two or three. They usually disappear by themselves within 10 days and do not leave scars. Larger sores, about ½ to 1½ inches (less than 3 centimeters) in diameter, are less common. These larger ulcers are irregularly shaped, can take many weeks to heal, and frequently leave scars.
People with a severe outbreak may also have a fever, swollen lymph nodes in the neck, and a generally run-down feeling.
Canker sores vs. cold sores
Canker sores and cold sores are different conditions:
- Canker sores appear as white circles with a red halo; cold sores are normally fluid-filled blisters.
- Canker sores appear inside the mouth; cold sores appear outside the mouth- often under the nose, around the lips, or under the chin.
- Canker sores are not contagious; cold sores are caused by the herpessimplex virus (HSV) and, more rarely, HSV-2 (the genital herpes virus). Cold sores are contagious.
When to see a doctor?
Common canker sores usually heal without the need for medical treatment. More severe or recurrent cases may be eased by prescribed treatments, although these do not “cure” the ulcers.
As a general guide, canker sores should be brought to the attention of a dentist or doctor when they:
- Persist for more than 2 weeks without improvement.
- Get worse – including while being treated with home remedies.
- Recur often (2-3 times a year or more) or are particularly numerous or severe.
- Are accompanied by other symptoms, such as fever, diarrhea, headache, or skin rash.
- Are thought to be part of another condition.
How is a canker sore diagnosed?
If you see your doctor or dentist about the pain caused by your canker sores, he or she will do a physical examination by looking in your mouth to diagnose the canker sores.
The good news is that the pain and discomfort of canker sores can be reduced by readily available prescription and non-prescription treatments and home remedies.
Simple cases of occasional canker sores are self-limiting; they will heal over and disappear without intervention. No remedies are proven to change the course of canker sores themselves or stop them returning – treatments mostly just reduce pain, discomfort, and complication. Few treatments marketed for canker sores have been through extensive clinical testing.
The management of canker sores is focused on treating symptoms, reducing inflammation, and promoting the healing process by countering secondary effects that could slow this down, such as bacterial infection. Treatments may include steroid mouth rinses, topical anesthetics, antiseptic ointments/rinses, or nutritional supplements.
Home remedies for canker sores
The home remedy below can be followed three or four times a day:
- Rinse with mild, over-the-counter mouthwash or salt water (do not swallow).
- Make a mixture that is half hydrogen peroxide and half water.
- Use a cotton swab to apply some of the mixture directly to the sore.
- Dab a small amount of milk of magnesia on the sore.
So-called alternative therapies may also be worth trying. A review listed a number of options, although it noted that there had been no randomized controlled trials to properly test safety and efficacy:
- Anecdotes of relief and better healing from sucking on zinc gluconate lozenges (sold for the common cold).
- Vitamin C, vitamin B complex, and lysine “may speed healing when taken orally at the onset of lesions.”
- Sage and chamomile mouthwash 4-6 times a day may help – infuse equal parts of the two herbs in water.
- Carrot, celery, and cantaloupe juices “have been reported as helpful.”
Prescription therapies for canker sores
More severe or persistent cases of canker sores need to be checked by a doctor to rule out associated conditions or to access prescription treatments. Again, any treatments aimed at the ulcers themselves are not certain to change their course, but can ease the symptoms.
Antibiotics may be prescribed to minimize inflammatory irritation whether or not a bacterial infection is present.
Anesthetics, as well as being available in consumer products for canker sores, may also be prescribed as topical preparations to ease irritation and pain.
Some medicines designed for other conditions can sometimes be used. scientists cite an association between recurrent cases of canker sores and an overactive immune system, so topical immunosuppressant medications may help, such as locally applied cortisone. With a similar mode of action, topical corticosteroids are often considered by doctors; these include clobetasol ointment, dexamethasone rinse, and fluocinonide gel (Lidex). One possible side effect of using corticosteroids against canker sores is a fungal infection in the mouth.
Particularly severe or recurrent cases of canker sores may be referred to an oral specialist who might consider systemic rather than locally applied (topical) drugs. These specialists may also be needed to make a more specific diagnosis – some rare cases of recurrent canker sores are diagnosed as Sutton disease, for example.
How can canker sores be prevented?
Most of the time the cause of canker sores is unknown. Unless you know what causes your canker sores, you cannot prevent them from happening. If you do know what causes your canker sores, you can help prevent them by avoiding what you know causes them. For example, if you have gotten canker sores in the past from hurting the inside of your mouth, you might help prevent them by chewing your food slowly and carefully, trying not to talk and chew at the same time, and using a soft-bristled toothbrush when you brush your teeth.
If you have gotten canker sores in the past by eating foods that have a lot of acid (such as citrus fruits or tomatoes) and sharp or harsh foods (such as bread crusts, corn chips, or potato chips), it might help to avoid these. Other ways that might help to prevent canker sores include limiting your use of alcohol and tobacco and controlling the stress in your life.
In general, it is important to get enough vitamins and minerals in your diet, like folic acid, vitamin B12, zinc, and iron.